针对台湾成年人的肾脏病饮食改良（MDRD）研究及慢性肾脏病流行病学合作（CKD-EPI）公式
Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults.
作者信息
Chen Ling-I, Guh Jinn-Yuh, Wu Kwan-Dun, Chen Yung-Ming, Kuo Mei-Chuan, Hwang Shang-Jyh, Chen Tzu-Hui, Chen Hung-Chun
机构信息
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
PLoS One. 2014 Jun 13;9(6):e99645. doi: 10.1371/journal.pone.0099645. eCollection 2014.
BACKGROUND
Estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations may not be accurate for Asians; thus, we developed modified eGFR equations for Taiwanese adults.
METHODS
This cross-sectional study compared the Taiwanese eGFR equations, the MDRD study, and the CKD-EPI equations with inulin clearance (Cin). A total of 695 adults including 259 healthy volunteers and 436 CKD patients were recruited. Participants from the Kaohsiung Medical University Hospital were used as the development set (N = 556) to develop the Taiwanese eGFR equations, whereas participants from the National Taiwan University Hospital were used as the validation set (N = 139) for external validation.
RESULTS
The Taiwanese eGFR equations were developed by using the extended Bland-Altman plot in the development set. The Taiwanese MDRD equation was 1.309 × MDRD0.912, Taiwanese CKD-EPI was 1.262×CKD-EPI0.914 and Taiwanese four-level CKD-EPI was 1.205 × four-level CKD-EPI0.914. In the validation set, the Taiwanese equations had the lowest bias, the Taiwanese equations and the Japanese CKD-EPI equation had the lowest RMSE, whereas the Taiwanese and the Japanese equations had the best precision and the highest P30 among all equations. However, the Taiwanese MDRD equation had higher concordance correlation than did the Taiwanese CKD-EPI, the Taiwanese four-level CKD-EPI and the Japanese equations. Moreover, only the Taiwanese equations had no proportional bias among all of the equations. Finally, the Taiwanese MDRD equation had the best diagnostic performance in terms of ordinal logistic regression among all of the equations.
CONCLUSION
The Taiwanese MDRD equation is better than the MDRD, CKD-EPI, Japanese, Asian, Thai, Taiwanese CKD-EPI, and Taiwanese four-level CKD-EPI equations for Taiwanese adults.
背景
使用肾脏病饮食改良（MDRD）研究方程或慢性肾脏病流行病学合作组织（CKD-EPI）方程估算的肾小球滤过率（eGFR）对亚洲人可能不准确；因此，我们为台湾成年人开发了改良的eGFR方程。
方法
这项横断面研究将台湾eGFR方程、MDRD研究方程和CKD-EPI方程与菊粉清除率（Cin）进行了比较。共招募了695名成年人，包括259名健康志愿者和436名慢性肾脏病患者。高雄医学大学附属医院的参与者作为开发集（N = 556）用于开发台湾eGFR方程，而台湾大学附属医院的参与者作为验证集（N = 139）用于外部验证。
结果
在开发集中使用扩展的布兰德-奥特曼图开发了台湾eGFR方程。台湾MDRD方程为1.309×MDRD0.912，台湾CKD-EPI方程为1.262×CKD-EPI0.914，台湾四级CKD-EPI方程为1.205×四级CKD-EPI0.914。在验证集中，台湾方程的偏差最低，台湾方程和日本CKD-EPI方程的均方根误差（RMSE）最低，而在所有方程中，台湾和日本方程的精密度最佳且P30最高。然而，台湾MDRD方程的一致性相关性高于台湾CKD-EPI方程、台湾四级CKD-EPI方程和日本方程。此外，在所有方程中只有台湾方程没有比例偏差。最后，在所有方程中，就有序逻辑回归而言，台湾MDRD方程的诊断性能最佳。
结论
对于台湾成年人，台湾MDRD方程优于MDRD方程、CKD-EPI方程、日本方程、亚洲方程、泰国方程、台湾CKD-EPI方程和台湾四级CKD-EPI方程。
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